PLANTAR FASCIITIS

The Baltimore Sun

So you spring out of bed, eager to meet the day, but a sharp pain -- which seems to shoot straight into your heel -- stops you in midstride. Ouch. It's enough to make anyone want to go straight back to bed. According to Dr. Stuart Miller, a foot and ankle orthopedic sub-specialist at Union Memorial Hospital, the diagnosis could be plantar fasciitis -- an inflammation of the plantar fascia, a band of tissue that extends along the bottom of the foot from the heel toward the toes.

What causes plantar fasciitis?

Plantar fasciitis is like a sprain of the tissue that connects the heel to the bones in the ball of your foot. You can think of the plantar fascia as a tie-bar of the arch of the foot -- it supports the arch so it doesn't collapse. If you put too much pressure on it, it gets inflamed -- and it tends to get inflamed and hurt at the heel rather than at the top of the foot. It feels like a pain shooting straight up into your heel. I've had this; I know what it feels like.

Often it's caused when the calf muscles tighten and don't let the connective tissue move as freely. That is why a lot of runners get this; their calf muscles have become overdeveloped and tight.

Why does it hurt so much at the beginning of the day?

You notice the pain in the morning because most people sleep with their foot in a relaxed position so the calf muscle gets (relatively) tight. You jump out of bed and put too much force on the plantar fascia and you resprain it every morning. With another kind of sprain -- a shoulder sprain, perhaps -- you would simply stop reaching for things or lifting, but with plantar fasciitis there is this tendency to reinjure it again and again.

How is plantar fasciitis treated?

Taking an anti-inflammatory (such as Motrin or ibuprofen or naproxen) helps. Ice helps. Some people roll a frozen soda can under their foot. But stretching the calf muscle is at the core of treatment.

There are other treatments: Cortizone injections quiet down the inflammation, but we do not recommend getting more than three injections in your lifetime. The cortizone can weaken the fascia and cause a rupture. And a second type of treatment, shock wave therapy, is about 70 percent effective.

Or, as a last resort, surgery can be done. ... But we have a high rate of nonoperative cures.

How do I know whether I need to consult a doctor?

When the pain doesn't go away over the course of several months with good stretching.

What do you tell your patients who are diagnosed with plantar fasciitis?

I begin by explaining why you are getting this pain: The calf muscles usually are too tight. Once you understand that, I show you stretches, including one that is a runner's stretch. You lean against a table with one foot forward and one foot back. The front leg is bent and the back is straight, and when you lean into it, you will feel the stretch below and behind the knee. A second stretch you can do sitting down: Cross your legs, grab your toes with one hand and massage the fascia with one hand.

Does it matter what kind of shoes I wear?

A comfortable shoe with a little bit of arch support will help. Sometimes people say their feet feel better in heels, that a high heel shoe feels better. But a heel can lead to a shortened calf muscle and worsen the problem. This is why more women than men have plantar fasciitis. You also can get orthotics, which can help by supporting the foot better and can lessen some of the mechanical strain.

Holly Selby

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